Insurance denial codes explained — what CO, PR, OA, and B mean on your EOB

CO-109

CO-109 Claim Sent to the Wrong Payer — What It Means and How to Fix It

CO-109 denial code description: Claim sent to the wrong payer — a routing error. CO-109 denial reason, solution, and free viability score. Medicare.

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CO-11

CO-11 Denial Code — Diagnosis Inconsistent With Procedure — What It Means and How to Beat It

CO-11 denial code description: Diagnosis inconsistent with procedure — a coding mismatch. CO-11 denial reason, solution, and free viability score.

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CO-119

CO-119 Denial Code — Benefit Maximum Reached — What It Means and How to Beat It

CO-119 denial code description: Benefit maximum reached — annual or lifetime cap. CO-119 denial reason, solution, and free viability score.

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CO-15

CO-15 Denial Code — Authorization Number Invalid or Missing — What It Means and How to Fix It

CO-15 denial code description: The authorization number is missing, invalid, or doesn't apply to the billed service. CO-15 denial reason, solution, and free viability score.

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CO-150

CO-150 Denial Code — Level of Service Not Supported — What It Means and How to Appeal

CO-150 denial code description: Payer says documentation doesn't support the level of service billed. CO-150 denial reason, solution, and free viability score. Medicare.

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CO-151

CO-151 Denial Code — Frequency Limit Exceeded — What It Means and How to Beat It

CO-151 denial code description: Frequency limit exceeded — too many visits or units. CO-151 denial reason, solution, and free appeal analysis. Medicare.

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CO-16

CO-16 Denial Code — Missing Information Denial — What It Means and How to Fix It

CO-16 denial code description: Missing or incorrect billing information. CO-16 denial reason, solution, and free viability score. Medicare and commercial.

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CO-167

CO-167 Denial Code — Diagnosis Not Covered — What It Means and How to Beat It

CO-167 denial code description: Diagnosis not covered under your plan. CO-167 denial reason, solution, and free appeal analysis.

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CO-18

CO-18 Denial Code — Exact Duplicate Claim — What It Means and How to Fix It

CO-18 denial code description: Exact duplicate claim — already submitted. CO-18 denial reason, solution, and free viability score.

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CO-197

CO-197 Denial Code — Prior Authorization Missing — What It Means and How to Beat It

CO-197 denial code description: Prior authorization missing or not on file. CO-197 denial reason, solution, and free appeal analysis.

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CO-204

CO-204 Denial Code — Drug, Equipment, or Service Not Covered — What It Means and How to Beat It

CO-204 denial code description: Drug, equipment, or service not covered. CO-204 denial reason, solution, and free appeal analysis.

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CO-22

CO-22 Denial Code — Coordination of Benefits — What It Means and How to Fix It

CO-22 denial code description: This care may be covered by another payer. CO-22 denial reason, solution, and how to route the claim correctly. Free viability score.

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CO-26

CO-26 Denial Code — Expenses Before Coverage Began — What It Means and How to Beat It

CO-26 denial code description: Expenses before coverage began — enrollment date error. CO-26 denial reason, solution, and free viability score.

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CO-27

CO-27 Denial Code — Coverage Terminated Before Care — What It Means and How to Beat It

CO-27 denial code description: Coverage terminated before care — COBRA and termination dates. CO-27 denial reason, solution, and free viability score.

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CO-29

CO-29 Timely Filing Exceeded — What It Means and How to Appeal

CO-29 denial code description: Timely filing exceeded — claim submitted after the deadline. CO-29 denial reason, solution, and free appeal analysis.

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CO-4

CO-4 Procedure / Modifier Mismatch — What It Means and How to Appeal

CO-4 denial code description: Procedure and modifier mismatch — a coding error, not a clinical denial. CO-4 denial reason, solution, and free viability score.

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CO-45

CO-45 Denial Code — Charge Exceeds Fee Schedule — What It Means

CO-45 denial code description: Charge exceeds contracted fee schedule — you do not owe this amount. CO-45 denial reason, what it means in medical billing, and when it signals a real problem.

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CO-50

CO-50 Not Medically Necessary — What It Means and How to Appeal

CO-50 denial code description: Not medically necessary — the most common denial and most overturnable. Denial reason, solution, and free appeal analysis.

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CO-55

CO-55 Denial Code — Experimental or Investigational — What It Means and How to Appeal

CO-55 denial code description: Treatment deemed experimental or investigational. CO-55 denial reason, solution, and how to appeal using peer-reviewed evidence. Free viability score.

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CO-58

CO-58 Denial Code — Invalid Place of Service — What It Means and How to Beat It

CO-58 denial code description: Invalid place of service — billing location mismatch. CO-58 denial reason, solution, and free appeal analysis.

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CO-96

CO-96 Denial Code — Non-Covered Charge — What It Means and How to Appeal

CO-96 denial code description: Non-covered charge — contractual obligation, not patient responsibility. CO-96 denial reason, solution, and how it differs from PR-96.

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CO-97

CO-97 Denial Code — Bundled Service — What It Means and How to Appeal

CO-97 denial code description: Service is included in another procedure's payment. CO-97 denial reason, solution, and how it differs from PR-97. Free viability score.

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CO-B7

CO-B7 Denial Code — Provider Not Certified — What It Means and How to Beat It

CO-B7 denial code description: Provider not certified or credentialed on service date. CO-B7 denial reason, solution, and free viability score. Medicare.

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PR-96

PR-96 Non-Covered Charge — What It Means and How to Appeal

PR-96 denial code description: Non-covered charge — patient responsibility. PR-96 denial reason, solution, and when to appeal. Free viability score.

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PR-97

PR-97 Bundled Charge Billed to You — What It Means and How to Appeal

PR-97 denial code description: Bundled service billed as patient responsibility. PR-97 denial reason, solution, and free viability score.

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OA-23

OA-23 Denial Code — Coordination of Benefits Adjustment — What It Means and How to Fix It

OA-23 denial code description: Coordination of benefits adjustment — primary and secondary payer math. OA-23 denial reason, solution, and free analysis.

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B15

B15 Denial Code — Qualifying Service Not Yet Adjudicated | What It Means and How to Fix It

B15 denial code description: Qualifying service not yet adjudicated — a sequencing hold, not a real denial. B15 denial reason, solution, and free analysis.

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